A hisztériával kapcsolatos diskurzusok tanulságai a szomatizációs jelenségek és a betegségmagatartás megértéséhez = The relevance of discourses about hysteria in the understanding of somatization phenomena and illness behaviour

Napjainkban a magatartástudományok képviselőinek egyszerre kell számolniuk a betegségekkel kapcsolatos bizonyosság és tudás konfliktusait előhívó medikalizációs-technicizációs orvostudományi tendenciákkal és a társadalomtudományok ezekre reflektáló, kritikai és „posztmodern” megközelítéseivel. Ebből adódóan igen fontos kihívásként jelentkezik az interdiszciplináris megközelítés szükségessége. Különösen így van ez a nehezen definiálható betegségek - a szomatizációs és pszichoszomatikus zavarok - esetében, ahol a betegségmagatartás gyakorlati problémái, továbbá a tünetek, a diagnózisok és a szenvedés „valódiságának” episztemológiai kérdései egyszerre vannak jelen. Az utóbbi másfél évtized kritikai társadalomtudományi kutatásaiban rendkívüli figyelmet kapott a szomatizációs zavarok és a klasszikus pszichoszomatikus kórképek elődjének számító hisztéria kérdésköre. A tanulmány a szakmai és laikus szóhasználatban nem hivatalosan máig tovább élő betegséggel kapcsolatos társadalomtudományi és orvosi megközelítések közül azokat mutatja be, amelyek szempontokkal szolgálhatnak a szomatizációs és pszichoszomatikus kórképek, valamint a velük kapcsolatos érzelmi és viselkedéses reakciók elemzéséhez és megértéséhez

Responses to the publication of the American Psychiatric Association’s DSM 5

The idea and practice of ‘diagnosis’ in psychiatry has always been controversial. Controversy came to a head in the period preceding and immediately after publication of the latest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, DSM-5. There was widespread international discussion and debate not only in scholarly journals but in mainstream and social media, and to the formation of International DSM Response Committee and an International Summit on Psychiatric Diagnosis. This article documents that process and outlines the issues that provoked, and continue to provoke most controversy, from the (admittedly personal) perspective of those involved. It ends with suggestions of alternatives to diagnosis, which avoid some of these problems and outlines how these are being taken forward. The next ten years are likely to see significant change

Universal cures for idiosyncratic illnesses: a genealogy of therapeutic reasoning in the mental health field

Over the past decades, there has been a significant increase in prescriptions of psychotropic drugs for mental disorders. So far, most of the explanations of the phenomenon have focused on the process of medicalization, but little attention has been cast towards physicians' day-to-day clinical reasoning, and the way it affects therapeutic decision-making. This article addresses the complex relationship between aetiology, diagnosis and drug treatment by examining the style of reasoning underlying prescribing practices through an historical lens. A genealogy of contemporary prescribing practices is proposed, that draws significant comparisons between 19th-century medicine and modern psychiatry. Tensions between specific, standardized cures and specific, idiosyncratic patients have been historically at play in clinical reasoning - and still are today. This inquiry into the epistemological foundations of contemporary drug prescription reveals an underlying search for scientific legitimacy

Vitalism in contemporary chiropractic: a help or a hinderance?

Background: Chiropractic emerged in 1895 and was promoted as a viable health care substitute in direct competition with the medical profession. This was an era when there was a belief that one cause and one cure for all disease would be discovered. The chiropractic version was a theory that most diseases were caused by subluxated (slightly displaced) vertebrae interfering with “nerve vibrations” (a supernatural, vital force) and could be cured by adjusting (repositioning) vertebrae, thereby removing the interference with the body’s inherent capacity to heal. DD Palmer, the originator of chiropractic, established chiropractic based on vitalistic principles. Anecdotally, the authors have observed that many chiropractors who overtly claim to be “vitalists” cannot define the term. Therefore, we sought the origins of vitalism and to examine its effects on chiropractic today. Discussion: Vitalism arose out of human curiosity around the biggest questions: Where do we come from? What is life? For some, life was derived from an unknown and unknowable vital force. For others, a vital force was a placeholder, a piece of knowledge not yet grasped but attainable. Developments in science have demonstrated there is no longer a need to invoke vitalistic entities as either explanations or hypotheses for biological phenomena. Nevertheless, vitalism remains within chiropractic. In this examination of vitalism within chiropractic we explore the history of vitalism, vitalism within chiropractic and whether a vitalistic ideology is compatible with the legal and ethical requirements for registered health care professionals such as chiropractors. Conclusion: Vitalism has had many meanings throughout the centuries of recorded history. Though only vaguely defined by chiropractors, vitalism, as a representation of supernatural force and therefore an untestable hypothesis, sits at the heart of the divisions within chiropractic and acts as an impediment to chiropractic legitimacy, cultural authority and integration into mainstream health care

What is psychiatry? Co-producing complexity in mental health

What is psychiatry? Such a question is increasingly important to engage with in light of the development of new diagnostic frameworks that have wide-ranging and international clinical and societal implications. I suggest in this reflective essay that ‘psychiatry' is not a singular entity that enjoins consistent forms of critique along familiar axes; rather, it is a heterogeneous assemblage of interacting material and symbolic elements (some of which endure, and some of which are subject to innovation). In underscoring the diversity of psychiatry, I seek to move towards further sociological purchase on what remains a contested and influential set of discourses and practices. This approach foregrounds the relationships between scientific knowledge, biomedical institutions, social action and subjective experience; these articulations co-produce both psychiatry and each other. One corollary of this emphasis on multiplicity and incoherence within psychiatric theory, research and practice, is that critiques which elide this complexity are rendered problematic. Engagements with psychiatry are, I argue, best furthered by recognising its multifaceted nature